Child life specialists involve play
in coping

by Child
Life Department staff
The Child Life Department at MUSC Children’s Hospital is designed to
address the unique psychosocial needs of children, adolescents and
their families during medical events. A primary goal is to minimize the
stress associated with health care while facilitating opportunities for
positive coping.

Kali Kinloch, 9,
paints a ceramic piggy bank with Lindsay Gallapher, a child life
specialist in the Children's Hospital Atrium and Radiology.

During the month of March, child life specialists around the world have
the opportunity to promote awareness of the child life profession and
describe their role within the hospital setting. Child Life Month is a
chance to help educate fellow hospital staff, families and patients
concerning the role and mission of the Child Life Department.

The department has taken this opportunity to answer some frequently
asked questions concerning our professional role, tips for staff
working with children and also some ideas for parents concerning
medical encounters with their children.

Child life specialists have
a fun job because you get to play all day with children. What else does
your job entail besides playing?
The goal of child life specialists is to promote effective coping for
children through play, preparation for procedures, education, and
self-expressive activities. The team is also able to provide education
to other medical professionals about how children cope, developmental
expectations for individual children, and advocate for family centered
care.

The play that specialists are involved in can have many purposes. Staff
regularly use play and activities as therapy. This use of play can help
children and teenagers express themselves, as they sometimes do not
have adequate outlets for their thoughts, feelings and anxieties. It is
a great and natural way for patients to manage their stress. Sometimes
staff use medical play to help children explore different elements of
hospitalization. During medical play, patients are able to use special
dolls and real medical equipment in a safe way to learn about their
diagnoses and procedures; this also promotes control of their hospital
experience. Play is also essential for children and teenagers in
reaching developmental milestones.

My daughter is looking into
colleges and is interested in a career in child life. What
qualifications or degree do you need to become a child life specialist?
To become a child life specialist, your daughter must seek a bachelor’s
degree or higher in child development, early childhood education, child
life, special education, or a closely related field that emphasizes
human growth and development.

Many colleges have child life tracks that include the intense study of
development, children’s responses to stress and hospitalization, family
centered care, and play therapy. Those seeking to become a child life
specialist must complete an internship program under the direction of a
certified child life specialist and participate in a rigorous
application process.

Upon completion of an internship, prospective child life specialists
must complete the National Child Life Professional Certification Exam
and maintain certification yearly through professional development
hours or recertification. Many specialists, including those here are
MUSC, have a master’s degree.

For more information on colleges offering child life programs or
additional requirements, consult the Child Life Council Web site at http://www.childlife.org.

My 9-year-old son has to
have surgery in a month. When is the best time to tell him? He
was at the appointment with us when the doctor told us but I am not
sure he even heard. How do we best prepare him? Should we even tell him?
When it comes to preparing children for surgery, honesty goes a long
way. Children need to know what to expect and have opportunities to be
involved in planning for their hospital experience. Also, advance
notice allows children time to process their feelings, to ask questions
and to express concerns. Your son likely heard at least some of what
the doctor said but may not have understood or is scared to ask about
it, hoping it will just not happen!

For school-age children, a week-to-two weeks notice is important. Many
hospitals, like MUSC, offer a preoperative tour for children and their
families prior to surgery. This is a chance to see and experience the
area before being a patient.

You can find more information about preparing children of all ages for
hospital visits and surgery on http://www.musckids.com.

My 4-year-old child has
always done well going to the doctor until recently. We had to go
to see his pediatrician the other day for an earache and he cried the
whole time we where there. When we were out of state on vacation last
year, he fell and had to have stitches. I don’t remember it being that
traumatic of an experience for him except that they had to lay on him
to put the IV in. Could this really have affected him to this
degree?
Absolutely! Children build on their past medical experiences (negative
or positive). How they cope can determine how they may act during
future health care experiences. This is why we find it so important to
help children and families have positive experiences here in the
hospital. Your child being held down helped contribute to his fear of
the medical staff. A better scenario would have been to have you hold
your son in a “comfort hold” while starting his IV.

A comfort hold is important for the following reasons: Upright
positions promote a sense of control and security; and the parent is
the one comforting the child and not restraining the child (a parent
should never be required to restrain their child for a medical
procedure).

What are some tips for us
(staff who work with children) to help children when they have to have
an IV or any other type of injection?

Use pain management medications available in your area,
such as Emla or Synera.

Have IV materials set up and out of sight, preferably
before the child is brought in.

Use positions that are comforting to a child rather than
restraining, such as a comfort hold or sitting in a lap of a trusted
caregiver.

Build rapport with child and family by asking non-medical
questions about outside interests and activities.

Explain what the child can expect during the procedure
using child- friendly language.

Give the child and caregiver a job to increase their sense
of control. i.e., telling a child that their job is to hold their arm
still, can reduce their anxiety and give them something to focus on.

Give child and caregiver the option to look at the
injection/IV start or to look away.

Let the child know it is OK to cry.

Help children cope by offering something else for them to
focus on during IV start/injection such as, bubbles, books, singing, or
music.

Give praise when finished, focusing specifically on what
the child did well during the procedure.

The Child Life Department at MUSC Children’s Hospital has 10 full-time
employees that staff all inpatient units of the hospital, the main
operating room, Ambulatory Surgery, Emergency Department, diagnostic
areas and several outpatient clinics.

Friday, March 21, 2008Catalyst Online is published weekly,
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